Every year, American hospital workers suffer about 385,000 sharps-related injuries, according to the Centers for Disease Control and Prevention. The cost of these incidents to healthcare facilities is more than just financial. The loss of staff time to injuries and investigations and the expense of testing and treatment — not to mention the potential payment of disability benefits and hiring of replacements — are compounded by the human toll that the injury and possible exposure to infectious materials may take on your employees' physiological and mental health. Incorporating sharps safety into your facility's practices can help to protect your staff. Here are some strategies toward achieving that goal.

Start with self-assessment
The Occupational Safety and Health Administration's Bloodborne Pathogens Standard makes creating and regularly updating an exposure control plan mandatory for healthcare facilities. This document requires you to detail which members and departments of your staff are at risk of exposure to bloodborne pathogens, through sharps injuries or other means. It also outlines the training and engineering controls in place to protect against such risks, including the practices taught, the personal protective equipment available and the staff-wide hepatitis B vaccinations given. As a result, its drafting will require you not only to educate yourself about what federal regulations require, but also to monitor your facility's and your staff's practices in depth.

A successful sharps safety campaign, like a thorough exposure control plan, should begin with an identification of your facility's risks and of its sharps injury incidents, says Angela K. Laramie, MPH, project coordinator for the Massachusetts Department of Public Health's Sharps Injury Surveillance Program in Boston. "Know your data," she says. "See when, where and how these injuries are happening, in which procedures they're happening, and who's getting injured." What you find out can highlight gaps in compliance with guidelines, direct your training efforts and help to support your exposure control plan.

In addition to the injuries themselves, pay close attention to the syringes, suture needles or scalpels involved in them. "Are the injuries happening with items that have safeguards, or with items without safeguards?" asks Ms. Laramie. Injuries that could have been prevented if the instrument in use had been a safety-engineered version are one issue. Injuries that could have been avoided if an instrument's safety features had been engaged are quite another. "If available features weren't used, why not? Because your practitioners choose not to use them? Or say they cannot?" When a member of your staff isn't activating the safety feature, she notes, there's either a problem with the instrument's design, which must be rectified by replacing it with another type of instrument, or you've got practice issues, which require immediate remediation.

The importance of involvement
Identifying risks, drafting an exposure control plan and implementing sharps safety efforts aren't jobs you'll be taking on by yourself. "This is a multi-disciplinary effort, no one can do it on their own," says Mary J. Ogg, MSN, RN, CNOR, a perioperative nursing specialist for the Association of periOperative Registered Nurses in Denver. "You need surgeons, nurses and surgical techs to pull it off."

Depending on your facility's size, the depth of your departments and the delegation of your duties, the infection preventionist, risk manager, materials manager and environmental services staff (who have to handle sharps disposal containers) might also be on the team. Otherwise the lack of multi-disciplinary support could doom any efforts toward consistent sharps safety compliance to failure.

Seeking and incorporating input from your front-line workers when you're improving clinical practices and converting to safety devices can provide a sense of ownership while fostering cooperation and compliance. "Then it's not some mysterious administrative decision," says Ms. Laramie. "People want to feel like they have some control. Otherwise, the result may be 'You can't make me.'"

Another way to involve and encourage your staff toward safer practices is to enlist a role model. "Identifying a physician and a staff 'champion,' people who are well-liked and well-respected within their respective communities, makes it easier to spread the word," says Ms. Ogg.

It's a key position in your sharps safety efforts, and one you'd best keep occupied. "This isn't a once-and-done thing," says Ms. Ogg, recalling a surgical facility that was successful in its adoption and consistent use of blunt-tip suture needles. When the surgeon champion left the facility's staff, however, they saw compliance rates fall. "That shows the importance of finding someone to fill that slot."

Don't train in vain
The ECRI Institute agrees that sharps safety must be a continually reviewed, continually updated process of quality improvement. The Plymouth Meeting, Pa.-based non-profit healthcare research organization listed needlesticks and other sharps injuries as one of its "Top 10 Health Technology Hazards for 2012" in the November issue of its Health Devices journal.

"Most hospitals have ongoing programs to address sharps safety," the article's authors write. "But these programs may have been established some time ago and may no longer be receiving adequate attention or achieving their expected level of effectiveness."

Another factor that can weaken the effectiveness of sharps safety efforts is that routinely repeated annual in-services and competencies on the subject may leave staff overly accustomed to the point of complacency. "If you can change up your training at all, then your staff will be less likely to say, 'This is the same bloodborne pathogens instruction I had last time,' and sit suffering through it just to get signed off on it," says Ms. Ogg. "If you refresh the program, you'll get a better response."

She recommends educators take advantage of resources provided by government agencies and professional organizations to vary their approaches to the subject. Her organization, AORN, offers a "sharps safety tool kit" as well as online videos and periodic webinars, which can be viewed live or replayed later. OSHA's letters of interpretation and consultation services expand upon its codified standards. Other sources for materials and data include the "Stop Sticks Campaign" from the CDC's National Institute for Occupational Safety and Health and the Exposure Prevention Information Network (EPINet) at the University of Virginia Health System's International Healthcare Worker Safety Center.

Your own facility may also be a valuable source of teachable moments, says Ms. Ogg. "Include the past year's sharps injuries, how they occurred and what could have been done to prevent them." And, since surgeons' minds tend to be receptive to evidence-based practices, show them the numbers. "If you keep exposing them to the value of blunt suture needles or safety scalpels, it could become second nature." Post summaries of clinical studies, along with changes in your facility's policies and news of new, safety-engineered products, in a place they'll have time to read them, such as over the scrub sink or in the lounge, she says.

Supplying your safety
Articles appearing in the October and November editions of AORN Journal reported that an increase in OSHA inspections had resulted in a rise in citations issued to ASCs and office-based practices. The most common cause for citation was a failure to comply with the agency's Bloodborne Pathogen Standard, either due to a substandard exposure control plan, a lack of sharps safety training or the absence of safety devices, which the standard demands you and your staff regularly evaluate and adopt. "Safety scalpel use has been increasing where OSHA's inspecting," says Ms. Ogg. "We would hope that the carrot [the benefits of safety] would work to get people to use them, but the stick apparently works better."

Still, it's a good idea to prepare yourself before the surveyors show up at your door. "If there's a safer device on the market that can be used, you have to evaluate it," says Ms. Ogg. "And you have to have the input of actual employees who'll be using it." If the device is rejected, "keep those comments for when surveyors come in, to let them know the reasons it wasn't accepted."

What's more, she says, "Just because someone doesn't like it isn't a reason not to adopt it. And just because you run an evaluation trial once doesn't mean you're done."

The first generation of safety-engineered scalpels, syringes, suture needles and other devices didn't always satisfy users, but many see promise in newer offerings and the medical device industry's attempts to develop acceptable alternatives to traditional instruments.

"The best designs are those that have single-handed activation, that keep your hand behind the point," says Ms. Laramie. "You want devices that are easy to understand with no extra steps," where activating the safety feature is followed immediately by unimpaired use.

In addition to evaluation, input and consensus-building, the administrator's role in supply purchasing may be a key step in a safety device conversion. "Take control over which devices enter your facility," she says. "There has to be some control, where a gatekeeper says 'No, you can't have those supplies without justification.'"

It's a blunt approach, so to speak, but it combats what an AORN online survey found to be the biggest obstacle to compliance with sharps safety protocols: the continued availability of conventional, non-safety-engineered devices. "Surgeons will fall back on those, because that's what's there," says Ms. Ogg. She describes one facility's solution: When they adopted blunt suture needles, they pulled all the needles that were replaced by the safety type and secured them in the surgical director's office. Surgeons who wanted to use them had to come to her office and ask for them in person, and presumably justify their need. "Not many came to her door," she says.

A change from within
For a study published in the June 2011 issue of the journal Infection Control and Hospital Epidemiology, Ms. Laramie and her colleagues, along with researchers at the Harvard School of Public Health and the University of Massachusetts Lowell, analyzed the 16,158 sharps injuries reported by the employees of 76 Massachusetts hospitals between 2002 and 2007. The annual incidence rate for injuries declined 22% during this time, an average decrease of 4.7% per year. When the researchers broke the data down into the occupations of the staff who were getting injured, though, they found that nurses were seeing a significantly greater decline (7.2% per year) than physicians (0.9%).

Staff can take proactive steps toward safety by choosing to double-glove (which both a leading supply manufacturer and a Cochrane Collaboration study have suggested decreases needlestick injuries), setting up a neutral zone or passing tray for no-hands passes, and by verbal cueing.

"People sometimes don't feel empowered to call out deficiencies in sharps safety management," says Ms. Ogg. "But they can. You can choose to protect yourself by changing your own practices of safety," and perhaps in that way influence the practices of the people around you. "We are getting the message out for that."